Fulminant ESBL E. coli Early Onset Sepsis in a newborn: A Case Report

Early-onset neonatal sepsis remains a major cause of morbidity and mortality in newborns, particularly when caused by multidrug-resistant organisms. Among these pathogens, extended-spectrum β-lactamase (ESBL)–producing Escherichia coli has emerged as a significant global health concern due to its resistance to commonly used antibiotics and its association with severe clinical outcomes. This case report describes a fulminant episode of early-onset sepsis in a 14-hour-old full-term neonate caused by ESBL-producing E. coli. The infant was born at 38 weeks and 5 days of gestation following prolonged rupture of membranes, maternal fever, and meconium-stained amniotic fluid, with suspected chorioamnionitis. Soon after birth, the neonate developed respiratory distress requiring continuous positive airway pressure and intensive supportive care. Despite empiric antibiotic therapy with ampicillin and gentamicin, the infant’s condition rapidly deteriorated. Blood cultures later confirmed ESBL-producing E. coli, prompting escalation to carbapenem therapy. However, the infection progressed aggressively, leading to respiratory failure, metabolic acidosis, and multisystem organ dysfunction. Despite advanced interventions including intubation, vasopressor support, and resuscitative efforts, the infant succumbed to the infection within 23 hours of life. This case highlights the rapid progression and high lethality associated with ESBL-related neonatal infections. It also underscores the importance of early recognition, prompt initiation of appropriate antimicrobial therapy, and increased surveillance of maternal colonization with multidrug-resistant organisms. Greater awareness and further research are needed to improve prevention strategies, diagnostic approaches, and treatment protocols for neonatal sepsis caused by resistant pathogens.